20180 - Laserfiche WebLink

Home Browse Search

I. FOR OFFICE USE: 4 ---------------------------------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. -- ------------------- (Complete in Duplicate) t Date Issued ------------------- ------------------------------------- This Permit Expires 1 Year p Issued - From Date Application is.hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. �rrfl_ Z3 JOB"ADDRESS'AND LOCATION_ __ - __ .------------ Owner's Name-------- ------------------------------------ ----------- ------------- ------- Phone...-•---------------------::_...---- Address12a---=- --- u1`r• --------------------•---------------------------------•----.....---------------•---•--''---------- __ _ F ______________________�.__�r-_-_ Contractor's Name. ff---------�-- lR` ,� f z`"'y`' Phone------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -/___- Number of bedrooms __ __ Number of baths _ Lot size -- ____________________________.._ Water Supply: Public system ❑ Community system ❑ Private e Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand p Gravel ❑ Sandy Loam [J Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date______--------- ---) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool pl rmitted if public sewer is available within 200 feet.) Septicank: Distance from nearest well--S6.......Dis#anFe from foundation_-.__!Q_�______Material._-- ------------------- No. -_-_________________ ~ No.-of com artments_______.-_____________Siz f _ -- r p, �.�1�---�--�--------Liquid depth--�--------------- capacity--«aQ- - � N Dispo Field: Distance from nearest well_.__ar'.�Q______Distance from foundation-----��`___..____.Distance to nearest lot ;ne'S____ _______ y Number-of-lines- 3____________ ______Length of each line----- ---_ _.______._..Width of trench-----Z____-___._____--_-__-._ Type of filter m to erial___-�t_�!--------Depth of filter material----�_f_I-----------Total length_____ZP—A-Z---'t----------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation---.----------------Distance to nearest lot line------------- f ❑ Number of pits.- ---------I_-------Lining material---=-- ------------ -Size: Diameter.-.--------------------Depth-----.-.-.--.-.---------- "----- b Cesspool: Distance from nearest wel ----------------- from foundation--------------------Lining material-----.------------------------------- F ❑ Size: Diameter--- --- --------------Depth---------------- ---------------------------------Liquid Capacity----------------------------gals. 1 1 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------"_____--_-_________.____..._. ❑ Distance to nearest lot.line--------------------------------- -------------•----------------------•---------------------------------------'= , Remodeling and/or repairing Idescribe)---------- ----------- ---------- ------ ----------------- ------------------------------------ ------------------? 9 -----•--------------------------------- # --------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. y (Signed) - -------- --- - 'fw ler and/or Contractor) r Br ;= '"------------------------------------------------------(Title]------ --------------------------------------------------- -- '... (Plot plan, showing size of lot, location of system i relation to wells, buildings, etc., can be placed on reverse side). 1 t I ' FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY-- --------------------------------------------------- DATE--- REVIEWEDBY- -------------------------------------------------- -- ------------------------------------------------------ DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations:--..---,--,---------I------------------------------------------------------------------------------------------------ ------- ----------------- --------------------- ----------------------------------------------------------------------------------------------------------------------------------=--------------------------------------------------------------------- -----•----•----- --•---------------- --------------------------------------- --------- -------------------------------------------------------------------- ---------------------- - --------------------------------- x ------------------------------- ------------:-- ----------------•-------------------------- ---------------------------------------•---- ---------------- ----------- ---- - ---------------------------- li FINAL INSPECTION BY:. Date. �L�- �' - { f SAN JOAQUIN LOCAL HEALTH DISTRICT J 1601 E.Hasolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C. } �r